Alzheimer's Disease Flashcards
What drugs are used to treat AD?
- Cholinergic drugs
- NMDA non-competitive antagonists
- Estrogen
- Ergoloid mesylate
- Block the breakdown of ACh
- Indirect cholinergic stimulants
- Require an intact cholinergic system in order to have an effect; Used for mild to moderate Alzheimer’s disease; Lose effectiveness as the disease progresses; Little benefit if Mini Mental Status Exam score is less than 12
- Do not alter the progress of the disease; May slow down or prevent the symptoms from progressing for short periods of time
- May help control some behavioral symptoms
Anticholinesterase inhibitors
ADRs: Nausea, vomiting and other cholinomimetic effects
What are the cholinergic drugs?
- Anticholinesterase
- Tacrine (Cognex) - hepatotoxic
- Donepezil – Aricept - Headache, generalized pain, fatigue, dizziness, insomnia, increased frequency of urination
- Galantamine (Reminyl) - Diarrhea, weight loss
- Rivastigmine (Exelon) - Weight loss, upset stomach, muscle weakness
Approved for moderate to severe AD; Moderate decrease in clinical deterioration; Only small positive effects of cognition, mood, behavior, ADLS; No benefit in mild disease
NMDA uncompetitive antagonsist
- memantine (namenda)
- better tolerated and less toxic than cholinesterase inhibitors
- ADR: Common: Confusion, dizziness, drowsiness, headache, insomnia, agitation, hallucinations, constipation
Less common: vomiting, anxiety, hypertonia, increased libido. Reported to induce reversible neurological impairments in patients with Multiple Sclerosis
Drug: Some suggestion that it may be neuroprotective; In animal studies, estrogen increases Ach activity in the basal forebrain; Little evidence to support a benefit in people
Estrogen
- some evidence that it may increase dementia
Drug: Thought to increase mental acuity and alertness in geriatric patients with dementia related to AD; Supposedly increases cerebral blood flow or oxygen utilization in the brain; Little evidence that there is a clinical benefit - EU does not permit because the risks outweigh the benefits
Ergoloid mesylate
- Fun fact: the same dude who developed this, also created LSD!
What are some preventative tx for AD?
- Statins
- Anti-amyloid strategies - blocking plaque formation (vaccine, worked in mice, produced encephalitis in humans w/o stopping cognitive decline)
- Theoretical basis for their use; Suggestions of benefits
Drug:
- Thought to act through altering amyloid regulation
- Factors increasing risk of AD in midlife: High systolic blood pressure, Elevated LDL, Elevated apolipoprotein E
Statins
What are some common behavioral symptoms that contribute to pt morbidity and caregiver stress?
- Sleeplessness
- Wandering and pacing
- Aggression and Agitation
- Anger
- Depression
- Hallucinations and Delusions
- Psychosis
- May become more common in the evening (sundowning) or during daily routines, especially bathing
What drugs are used to treat behavioral symptoms?
- Antipsychotic drugs - control aggression and agitation; concern for overuse
- Antiseizure drugs
- SSRIs
- off label use, no scientific evidence for benefits
What are some concerns with pharmacological tx of pts with AD?
- Liver or kidney disease may affect metabolism and levels of drugs
- Polypharmacy
- Can the patient recognize and mention adverse drug reactions
